Pregnancy

Question 1

What is the change in resting heart rate in pregnancy? What causes it?

Answer 1

Up 25% (5-10 in first trimester and 15 in 2/3)
Due to increase in oestrogen and hCG
SNS as well to stop BP dropping

Question 2

What is the change in stroke volume in pregnancy and why?

Answer 2

Increase 25%
Progesterone increases renin and therefore reabsorption and therefore blood volume
LV and contractility increases due to oestrogen and having more blood
10% in first trimester

Question 3

What is the change in plasma volume in pregnancy?

Answer 3

Up 35-50%

Question 4

What is the effect of pregnancy on BP and what blood related conditions may occur?

Answer 4

BP stays constant due to increased venous capacity negating increased CO
Potential anaemia as RBC do not increase as much as plasma
Risk of clots and varicose veins

Question 5

What are the pulmonary changes?

Answer 5

Elevation of diaphragm due to uterus reducing reserve volume
Ribs flair outwards reducing effectiveness
Increased work of breathing due to diaphragm resistance
Resting hyperventilation due to progesterone increasing CO2 sensitivity

Question 6

What is the effect of pregnancy on endurance athletes?

Answer 6

Initial improvement of performance for the first 15 weeks before weight and size start effecting as there is more blood
Then decrease due to foetal O2 demand and body mass

Question 7

What is the effect of pregnancy on substrate usage?

Answer 7

Increased CHO usage and maternal insulin (oestrogen stimulates beta cells)
May cause hypoglycaemia
Mum burns more of own body fat due to foetus needing glucose

Question 8

Explain gestational diabetes

Answer 8

Human placental lactogen counters insulin and insulin resistance is developed. More common in obese mothers and 60% go on to T2D
May cause large babies

Question 9

What is pre eclampsia and what is the effect of exercise?

Answer 9

High BP in pregnancy (3-7% prevalence)

Active women have 35-70% less preeclampsia possibly due to less CRP (vasodilation via more NO) and Leptin (less SNS)

Question 10

What are the GI changes in pregnancy?

Answer 10

Progesterone and larger uterus causes: constipation, less motility and relaxation of Lower oesophageal sphincter and therefore reflux

Question 11

What are the musculoskeletal changes of pregnancy?

Answer 11

Enlarged uterus and breasts affects centre of gravity, can cause back/shoulder pain and exaggerates lumbar lordosis
Lax joints and ligaments
Separation of abdominal muscles due to enlarging uterus 20-90% incidence

Question 12

Overall what is the changes in body mass and due to what?

Answer 12

12kg weight gain
Foetus 3.5
Uterus 1
Placenta 0.6
Amniotic fluid 0.8
Breasts 1.5
Maternal fluid 2
Maternal fat 2.5

Question 13

What is the acute effect of exercise on the foetus?

Answer 13

May cause less blood to uterus but the foetus can extract more
Foetal tachycardia due to heat and Catecholamines
Foetal bradycardia if hypoxia to reduce demands
If mum becomes hyperthermic would be bad as less heat gradient for baby to lose heat. Doesn’t seem to happen though

Question 14

What is the chronic effect of exercise on the foetus?

Answer 14

Inconsistent evidence about birth weight but seems fine if positive energy balance maintained. Too much in late pregnancy may make baby thinner
I theory shorter gestation but no evidence

Question 15

What are some contraindications for exercise in pregnancy?

Answer 15

Heart disease, restrictive lung, incompetent cervix, risk of premature labour
Relative - severe anaemia, dysthymia, bronchitis, T1DM
During - very out of breath, chest pain, dizzy, contractions

Question 16

What considerations should there be for exercise in pregnancy?

Answer 16

Hyperthermia - clothing/environment/<32 degree pool
BP - slow rise from floor
2nd/3rd trimester - don’t exercise supine or on right side due to vena cava compression
Avoid risk of abdominal trauma, heat and diving

Question 17

What are the exercise recommendations in pregnancy?

Answer 17

Aerobic - 3-7 days, low impact, 15-30 mins, 40-90% HRmax
Resistance training - 12-15 reps, light, abdominal conditioning not supine and be careful with linea alba weakness
Stretch - careful as balance is bad
Cooldown

Question 18

What is the change in calorie intake in pregnancy?

Answer 18

1 - 100
2 - 300
3 - 450

Question 19

What exercise recommendations are there for post partum?

Answer 19

If uncomplicated pregnancy - begin walk, pelvic floor and stretch
Complicated/caesarean - start after 6-8 weeks

Question 20

What is the overall cardiovascular change in pregnancy?

Answer 20

Increase cardiac output by 30-50%